California AG and 21 States Oppose Tying ACA Tax Credits to Abortion Restrictions

California Attorney General Rob Bonta, alongside a coalition of 21 state attorneys general, has sent a letter to U.S. congressional leadership opposing the linking of Enhanced Premium Tax Credits (PTCs) under the Affordable Care Act (ACA) extension to new abortion restrictions. The coalition argues that conditioning the extension of these tax credits on abortion coverage bans infringes upon state sovereignty and threatens access to critical healthcare services for millions of Americans. The Enhanced Premium Tax Credits, designed to reduce healthcare costs, are set to expire at the end of the year, which could lead to significant premium increases if not renewed. The letter highlights that the ACA framework was designed to respect state flexibility, including decisions related to abortion coverage. Many states in the coalition mandate or permit abortion coverage under marketplace insurance plans, with separate fees imposed to cover these services, in compliance with federal law that restricts the use of federal funds for abortion except in limited cases. A prohibition on abortion coverage would impact hundreds of thousands of reproductive-age women enrolled in marketplace plans in these states. The attorneys general emphasize that current law prohibits federal premium tax credits from directly funding abortion services, except in instances involving life endangerment, rape, or incest. State laws and insurance structures ensure segregation of funds to prevent federal dollars from being used for abortion coverage. The coalition warns that restricting access to abortion services could have adverse public health consequences, referencing increases in sepsis, infant mortality, and pregnancy-related deaths observed in states with tighter abortion restrictions. This objection follows previous federal attempts to limit reproductive healthcare access, including efforts to defund Planned Parenthood and restrict abortion services within Veterans Affairs medical centers. Attorney General Bonta and other state leaders have actively opposed these measures through legal action, including lawsuits and injunctions. The coalition of attorneys general spans 22 jurisdictions, reflecting a significant state-level opposition to conditional extension proposals tied to abortion coverage restrictions. The letter underscores the importance of maintaining the ACA’s Enhanced Premium Tax Credits without additional stipulations, emphasizing the need to protect affordable healthcare access and uphold state authority over health policy decisions. This ongoing debate has notable implications for health insurers and providers operating within these states, as regulatory changes could affect insurance coverage design, compliance requirements, and healthcare costs for consumers on marketplace plans.